Nursing Elites

1. A child with cystic fibrosis is admitted to the hospital with respiratory distress. Which intervention should the practical nurse (PN) implement?

• A. Administer bronchodilators as prescribed.
• B. Limit fluid intake.
• C. Provide a high-fat diet.
• D. Encourage bed rest only.

Correct answer: A

Rationale: Administering bronchodilators as prescribed is crucial for managing respiratory distress in children with cystic fibrosis. Bronchodilators help to open the airways, facilitating easier breathing for the child. Limiting fluid intake, providing a high-fat diet, or encouraging bed rest only are not appropriate interventions for respiratory distress associated with cystic fibrosis. Limiting fluid intake could worsen dehydration, a high-fat diet is not recommended due to pancreatic insufficiency in cystic fibrosis, and bed rest alone does not address the respiratory distress.

2. A child who weighs 25 kg is receiving IV ampicillin at a dose of 300 mg/kg/24 hours in equally divided doses every 4 hours. How many milligrams should the nurse administer to the child for each dose?

• A. 1875 mg
• B. 625 mg
• C. 2000 mg
• D. 1500 mg

Correct answer: A

Rationale: To calculate the correct dose for each administration, you first need to find the total daily dose: 300 mg/kg * 25 kg = 7500 mg/day. Since this total dose is divided into equally divided doses every 4 hours, there are 6 doses in 24 hours. Therefore, 7500 mg ÷ 6 doses = 1250 mg per dose. The nurse should administer 1250 mg every 4 hours, resulting in a total of 1875 mg for each dose in a 24-hour period. Choice A, 1875 mg, is the correct answer. Choice B, 625 mg, is incorrect as it does not consider the total daily dose and the frequency of administration. Choice C, 2000 mg, is incorrect as it is not the calculated dosage based on the given parameters. Choice D, 1500 mg, is also incorrect as it does not reflect the correct dosage calculation for each dose.

3. The heart rate for a 3-year-old with a congenital heart defect has steadily decreased over the last few hours, now it's 76 bpm, the previous reading 4 hours ago was 110 bpm. Which additional finding should be reported immediately to a healthcare provider?

• A. Oxygen saturation 94%.
• B. RR of 25 breaths/minute.
• C. Urine output 20 mL/hr.
• D. BP 70/40.

Correct answer: D

Rationale: A significant drop in heart rate and blood pressure should be reported immediately as it may indicate worsening of the congenital heart defect. A decrease in blood pressure may suggest poor cardiac output and compromised perfusion, requiring urgent medical attention. The other findings (oxygen saturation of 94%, RR of 25 breaths/minute, and urine output of 20 mL/hr) are within normal ranges for a 3-year-old and do not indicate immediate deterioration of the heart defect.

4. The nurse is conducting an admission assessment of an 11-month-old infant with CHF who is scheduled for repair of restenosis of coarction of the aorta that was repaired 4 days after birth. Findings include blood pressure higher in the arms than the lower extremities, pounding brachial pulses, and slightly palpable femoral pulses. What pathophysiologic mechanisms support these findings?

• A. The aortic semilunar valve obstructs blood flow into the systemic circulation
• B. The lumen of the aorta reduces the volume of the blood flow to the lower extremities
• C. The pulmonic valve prevents adequate blood volume into the pulmonary circulation
• D. An opening in the atrial septum causes a murmur due to a turbulent left-to-right shunt

Correct answer: B

Rationale: The correct answer is B. Coarctation of the aorta causes narrowing of the aorta, reducing blood flow to the lower extremities. This narrowing results in higher blood pressure in the arms compared to the lower extremities, along with stronger brachial pulses and slightly palpable femoral pulses. Choices A, C, and D are incorrect because they do not align with the pathophysiological mechanism of coarctation of the aorta, which specifically leads to reduced blood flow to the lower extremities.

5. In a 7-year-old child with a history of asthma experiencing an acute asthma exacerbation and displaying wheezing and the use of accessory muscles to breathe, what is the nurse’s priority intervention?

• A. Administer a nebulized bronchodilator
• B. Obtain an arterial blood gas
• C. Start the child on oxygen therapy
• D. Notify the healthcare provider

Correct answer: A

Rationale: The correct answer is to administer a nebulized bronchodilator. During an acute asthma exacerbation in a child with wheezing and increased work of breathing, the priority intervention is to provide immediate bronchodilation to dilate the airways, relieve bronchospasm, and improve breathing. This intervention aims to manage the acute asthma attack effectively and prevent further respiratory distress. Obtaining an arterial blood gas, starting oxygen therapy, or notifying the healthcare provider are important actions, but administering a bronchodilator takes precedence in addressing the acute respiratory compromise.

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